The commission that advises Seattle Mayor Mike McGinn, the City Council and municipal agencies on LGBT issues saw something it didn't like-the city's transgender employees are excluded from all of the health plans the city offers.

Members of the Seattle LGBT Commission wrote to Councilmember Bruce Harrell, who chairs the Energy, Technology and Civil Rights Committees, to urge the city to eliminate these exclusions and to cover trans-specific surgical, hormonal, psychological and medical care. The response from Harrell, his City Council colleagues and McGinn himself was a resounding "huh?" They simply didn't know this exclusion even existed.

"These exclusions have devastating effects on transgender employees," wrote commission members. "The exclusions promote negative messaging and discrimination, and they prevent employees from accessing care that could increase their safety, comfort and work performance."

The city's Benefit Plan specifically reads the policy will not cover sex-reassignment surgery and "any treatment, drug, service or supply related to changing sex or sexual characteristics." These include surgical procedures to "alter the appearance or function of the body," hormones and hormone therapy, prosthetics and medial or psychological counseling.

Commission officials maintain this broad exclusion has devastating consequences. They stress trans city employees who are denied coverage could develop debilitating secondary medical conditions, have substantially higher risk for suicide and experience increased psychological distress. Officials further contend an insurance company will deny coverage of other basic medical and psychological care it erroneously assumes are related to a person's gender identity and expression.

"Many of the transgender individuals we know describe this as common practice and affirm that it has happened to them," said commissioners. "They describe that once the term 'transgender' is in the chart, mental health, steroids, or procedures are universally denied. This experience is unfair especially as non-transgender patients do not have to prove medical necessity for any number of health care services. This exclusion should be removed."

Precedents and Cost EffectivenessCommissioners certainly did their homework. When Tiffany Nelson, who is also an employee at Group Health, and other commissioners learned of this injustice, they set out to change the way the city does business with its trans employees. She told EDGE that she and her colleagues first needed proof that these efforts have worked in other cities.

San Francisco provides an example of how including trans municipal employees in their insurance plans is a good thing. In 2001, the city added these benefits to the plan under which 100,000 municipal employees, retirees and dependents are covered.

San Francisco officials anticipated 35 people would file claims of approximately $50,000. The city added $1.70 in additional premiums from 2001 to 2004 in anticipation of increased demand and costs associated with these benefits. The city collected $4.3 million, but it only paid out $156,000 on seven claims. This allowed San Francisco officials to negotiate lower rates for the subsequent years. And in 2006 the benefit was no longer a separately added benefit, but rather a part of the services provided as a complete package. The city increased premiums for trans coverage totaling $5.6 million during the period between 2001 and 2006, but only paid out $386,417 in claims.

"It is a common misperception that adding transgender coverage will result in employees rushing to schedule expensive procedures-San Francisco's experience demonstrates that a large city can plan and budget to include these benefits without experiencing skyrocketing utilization, and that there is no need to separately rate and price the transgender benefit," commissioners told Harrell. "The city of Seattle can negotiate with health insurance providers for a plan that treats the benefit for transgender procedures the same as all other medical procedures and does not require an additional premium or a very minimal increase."

Commission, Mayor and City Council on the Same PageWhen word of the exclusion became known, local politicians quickly spoke out in support of changing the policy.

"As we all know, the health coverage offered to city employees is critically important," said Harrell in a press release and in a letter he wrote to commissioners. "As we continue to contain our costs of health coverage, we believe it is equally important to consider the values, purpose and actions contemplated by our city's commitment to social justice and fairness to all employees."

He said Seattle officials have long recognized the city's trans employees. "We believe that our support for all employees should not be based on whether an individual has identified themselves as a member of the transgender community," said Harrell. "Our actions as a city, including the negotiation of benefits in health coverage packages, should recognize this important commitment."

Harrell added his colleagues remain committed to ensuring trans Seattleites are treated equally-and they oppose any form of discrimination based on a person's gender identity and expression.

"That being the case, we believe that the request to consider the removal of transgender specific insurance plan exclusions for our employees is a topic that should be considered and evaluated during your ongoing discussions," he concluded.

The Health Care Committee will take up this issue at their next meeting, although nothing has been set in stone as of yet.

For his part, McGinn said the issue is something on which the city should be working. He described the health care exclusions as a fundamental issue that effects a person's physical and emotional well-being.

Approximately 10,000 municipal employees are currently covered under the city's health insurance plans, but the number of those who are trans remains unknown.

City Councilmember Sally Clark the trans exclusion also took her by surprise. She said that when commissioners began to look into the problem, they found out that the boilerplate language had been in the city's policies for years. "I want to change this," added Clark. "A lot of us do. Unfortunately it is not quite as easy as myself or Mayor McGinn standing up and waving a magic wand to just make something happen but we are committed to seeing this move forward."

"In a city as enlightened as Seattle, it was only a matter of time before this would get noticed," she said. "There is no reason not to undo this. It is not as if Transgender employees are 'up to something' to get the benefit. These benefits are being denied on a discriminatory basis and it's time to fix that."

Keisling concluded this issue breaks down to medical necessity.

"Healthcare benefits are only triggered when a doctor says it is medically necessary," she said. "That is a decision made by medical professionals, not bureaucrats. I think most Americans understand that."

Shaun Knittel is an openly gay journalist and public affairs specialist living in Seattle. His work as a photographer, columnist, and reporter has appeared in newspapers and magazines throughout the Pacific Northwest. In addition to writing for EDGE, Knittel is the current Associate Editor for Seattle Gay News.